Teaching Hospital In India Research Articles

A clinical study of patients with acute pancreatitis in North Indian teaching hospital

Background: Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. Acute pancreatitis is a significant health problem which leads to a quarter of million hospital admissions in USA per year. Aims and Objectives: To Study of Patients with Acute Pancreatitis in North Indian Teaching Hospital. Subjects and Methods: Acute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive measures to severe disease with life-threatening complications. After approval from ethical institutional committee a cross-sectional study was carried out at the Department of Surgery in the patients diagnosed as Pancreatitis during one year period i.e. June 2016 to May 2017. During one year period there were 78 patients enrolled into the study. Al details of the patients like age, sex, clinical features, etiological features, Outcome like Improved, DAMA (Discharge against Medical Advise) and Death and associated factors were studied in details. The data was presented in percentages and presented in the tabular form.Result: Therefore present study is stating that the majority of the patients were in the age group of 40- 50 were 40.0%, followed by 30-40 were 31.25%, 50-60 were 11.25%, >60 were 10.0%, 20-30 were 7.5%. The majority of the patients were Female i.e. 62.50%, and Male were 37.50%. The most common clinical presentation was Pain in abdomen i.e. 90%, followed by Fever 83%, Vomitting-78%, Jaundice 62%, Septicemia Shock in 32%. The most common etiology fond was Biliary in 52.78%, Alcoholism in 19.44%, Hyperlipidemia in 16.67%, idiopathic in 6.94%, traumatic in 4.17%. 85% Patients Improved, 5% patients discharged by Discharge against medical advice (DAMA) and Death occurred in 10% of the individuals; these patients were associated with old age, co- morbid conditions like Diabetes, Heart disease, Obesity etc. Conclusion: It can be concluded from our study that the most common clinical presentation was Pain in abdomen, followed by Fever, Vomiting, Jaundice, Septicemic Shock. The most common etiology fond was Biliary followed by Alcoholism, Hyperlipidemia, Idiopathic Traumatic, etc. In outcome majority of the Patients Improved Death occurred in 10% of the individuals; these patients were associated with old age comorbid conditions like Diabetes, Heart disease, Obesity etc.

In-hospital mortality and its predictors in a cohort of SLE from Northern India.

Mortality in SLE has a bimodal peak with early deaths mainly related to disease activity and infection. Although mortality has reduced over years, it is still two to three folds compared to the general population. In India due to increased burden of infection and limited access to health care, the causes may be different. Retrospective, review of records of all adult SLE patients fulfilling ACR 1997 criteria, who died in hospital between 2000-2019 at a teaching hospital in India was done. In addition, baseline clinical features were extracted for all adult SLE patients seen during this period.Infections were either bacteriologically proven or based on clinicradiological or serologic evidence. Active disease was defined as SLEDAI 2k ≥ 5. Logistic regression was performed to ascertain risk factors for mortality. A total of 1337 (92% females) patient records were reviewed .The mean age at presentation was 29.9 ± 9 years.60-75% of patients had fever, mucocutaneous disease and arthritis, while nephritis, hematologic, serositis and neurologic involvement was seen in 48.6%, 43.2%, 16% and 10.3% respectively as presenting mainfestations. There were 80 in hospital deaths .Infection was the most common cause of death, with 37 due to infection alone and in 24 disease activity also contributed. Only 18 deaths were due to active disease. Among bacterial infections lung was the most common site and gram negative organism were the most common pathogens. There were 10 deaths due to Tuberculosis(TB) and half of them had disseminated disease. Patients with disease activity had a SLEDAI of 14.8 ± 6.4, with neurological, renal and cardiovascular involvement being the major contributors to mortality in 11, 7 and 6 cases respectively. Higher age at onset, male gender, fever, myositis, neurological, cardiovascular, gastrointestinal involvement, vasculitis, elevated serum creatinine at baseline were independent predictors of death. Infections are the most common cause of in-hospital mortality in SLE and TB still accounts for 15% of deaths related to infection. Vasculitis, myositis, cardiovascular and gastrointestinal involvement emerged as novel predictors of mortality in our cohort.

Recommendations for Safely Performing Major Head and Neck Surgery During the COVID-19 Pandemic: Experience with Implementation of a Workflow.

COVID 19 pandemic has affected the delivery of surgical services as a part of management of head and neck cancers all over the world. Since it may affect the overall cure as well as quality of life of these patients, it is necessary to continue providing surgical treatment but with minimal additional health hazards to the patient or the health care worker. For this, a workflow was formulated in a university teaching hospital in India with large head and neck cancer workload and implemented during the period of national lockdown. 125 major head and neck cancer cases were operated during this period out of which 25 patients were of high-risk status. Emergency (10%) and semi-emergency (83%) cases predominated with few electives. The number of noncancer reconstructive and craniomaxillofacial cases operated was 81, out of which 25% was of emergency in nature. When compared to the data of similar period in the previous year, 60% of the workload in the cancer-related cases could be offered surgical treatment, whereas the noncancer cases operated were only 25%. The workflow may be useful for all surgical departments in safely performing procedures during this pandemic or similar situations in future with suitable refinements.

Prevalence of Off-label Drug Use in Neonatal Intensive Care Unit of a Tertiary Care Teaching Hospital in India

Prevalence of Off-label Drug Use in Neonatal Intensive Care Unit of a Tertiary Care Teaching Hospital in India

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Evaluation and Reporting of Medication Errors (MEs) In A South Indian Teaching Hospital

Evaluation and Reporting of Medication Errors (MEs) In A South Indian Teaching Hospital

Clinical profile and outcome of organophosphorus poisoning in a tertiary care centre, a prospective observational study

Introduction: Acute organophosphorus (OP) pesticide poisoning is widespread in the developing world. Being predominantly an agricultural country, pesticides and insecticides are used abundantly for cultivation, and access to these poisonous chemical substances by the population is easy. The objectiveof the study was to identifythe nature of the demographic profile, type of compound, clinical manifestations, and outcome of organophosphate poisoning presenting to a tertiary care teaching hospital in India. Material and methods: A cross-sectional study was conducted among 100 patients admitted with OPC poisoning inthe department of general medicine,Velammal Medical College Hospital and Research Institute, Madurai from January 2016 to July 2019. The diagnosis was made based on history or evidence of exposure to OP compound within 24 hours; characteristic manifestations of OP poisoning include, miosis, fasciculations, excessive salivation, improvement of signs and symptoms with administration of atropine were recorded. IBM SPSS version 22 was used for statistical analysis. Results:The majority of the subjects were males(80%). The majority (66%) were in the age group of 21-40 years. The most common OPC to be consumed was Methyl parathion (27%), followed by chlorpyrifos (22%). The major GIT complications were abdominal pain/cramps (100%), followed by nausea and vomiting (83%). Mechanical ventilation was needed in 40% and mortality was reported in 25% of the subjects. Conclusion:OP poisoning affects resonantly males in their economically productive phase of life. Considering the high mortality, adequate strengthening of health services, especially at the primary level is the need of the hour.

STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE REGARDING BIOMEDICAL WASTE MANAGEMENT AMONG NURSING PERSONNEL WORKING IN TERTIARY CARE CENTER AT LUCKNOW, U.P.

Background: Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences. The best BMW management (BMWM) methods aim at avoiding generation of waste or recovering as much as waste as possible, rather than disposing. Adequate knowledge about the health hazard of hospital waste, proper technique and methods of handling the waste, and practice of safety measures is unsatisfactory between health providers. In view of the foregoing, we performed a qualitative study in a tertiary care teaching hospital in India to explore the perceptions of the nursing personnel working in the hospital regarding health care waste management.
 Aims and Objective: The present study was performed to assessing knowledge, attitude of nursing personnel regarding biomedical waste management.
 Materials and Methods: A cross sectional observational study conducted at the different indoor wards of tertiary care hospital of Lucknow. The sample for this study were sixty nursing personnel dealing with care of admitted patient and engaged to perform routine medical procedure like blood sampling, intravenous fluid administration, bed sore dressing etc. Quantitative data of subjects recorded were age of the subject, year of experience and training of BMW management. Qualitative data recorded were knowledge related to BMW management, colour of bin regarding waste disposal and practice of waste management guideline during routine medical procedure
 Results: Majority (75%) of subject were having working experience less than ten year and 21.7% of subject were having working experience between 10 to 20 year. Study results showed that 16.7% of subjects have taken training of BMW management before starting the job and 73.3% of subjects have not taken any training of BMW. Knowledge regarding BMW of study subjects showed that majority (77%) have average knowledge, 21.6% of subjects have good knowledge and rest 6.7% of subjects have poor knowledge of BMW management.
 Conclusion: The awareness and practices of the BMW management varied among nursing personnel and were not found to be satisfactory. For effective implementation of biomedical waste management practices in the hospitals continuous training program is mandatory to improve their knowledge and practice.
 Keywords: Bio-medical waste, Nursing personnel, knowledge, Practice

Outcome of bariatric surgery on hypothyroidism: experience from a tertiary care center in India.

Hypothyroidism is frequently found to be associated with morbid obesity. Effect of bariatric surgery on type 2 diabetes, hypertension, and sleep apnea has been studied extensively but there is a dearth of literature on its impact on thyroid function. We had published our experience of laparoscopic sleeve gastrectomy and its effect on hypothyroidism in morbidly obese patients previously. In this study, we have tried to evaluate the impact of bariatric surgery on the whole cohort of hypothyroid patients and compare the effect of various bariatric procedures on thyroid hormone replacement dose. To assess outcome of bariatric surgery on the hypothyroid patients and to compare the outcomes of laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, and one-anastomosis gastric bypass in terms of reduction of thyroid hormone replacement dosage. Tertiary care University Hospital, India; Government Practice. This is a retrospective analysis of a database of all bariatric procedures done in a single unit at a tertiary care teaching hospital in India. Morbidly obese patients with hypothyroidism on thyroxine replacement were identified and their preoperative and postoperative thyroid hormone replacement dosage (THR) and thyroid stimulating hormone levels were compared. Of 883 patients undergoing bariatric surgery, 180 patients were hypothyroid (on thyroxine replacement). Ninety-three patients were included in the final analysis. The mean age of the study population was 42.2 ± 10.4 years and the mean preoperative body mass index was 47.8 ± 8.3 kg/m2. Mean follow-up duration was 29.8 ± 19.6 months. The excess weight loss was 58.9%. Fifty-two (55.8%) patients had a decrease in the in THR dosage, 37 (39.8%) had no change in THR dosage, and 4 patients required an increase in THR dosage. Decrease of THR dose was observed in 61.7% patients in laparoscopic sleeve gastrectomy in comparison to 45.4% in bypass group. Bariatric surgery might cause reduction of thyroid replacement dosage in hypothyroid, morbidly obese patients.

Modified Ultrafast Papanicolaou Stain in Ultrasound Guided FNAC of Intra-abdominal Lesions.

Background & Objective:Modified Ultra-fast Papanicolaou (MUFP) stain has been developed from Papanicolaou stain (PAP) with the goal to improve staining quality, minimize staining time for obtaining immediate cytological diagnosis and to check specimen adequacy during Ultrasound guided Fine needle Aspiration Cytology (US guided FNAC). The aim of this research was to study the cytomorphological features of intra-abdominal lesions with help of US guided FNAC and to assess the diagnostic utility of Modified Ultrafast Papanicolaou stain in cytological diagnosis.Methods:This cross-sectional study enrolled consecutive 100 subjects in N.K.P Salve Institute of Medical Sciences and Research Centre, Nagpur, which is a tertiary teaching hospital in India, from July 2015 to June 2017 who underwent US guided FNAC for Intra-abdominal lesions. Fine needle aspiration was done under ultrasound guidance and the smears were divided into two groups. Wet smears were fixed in 95% ethyl alcohol for conventional PAP staining and air dried for MUFP. After staining, results were evaluated on basis of the cytological features. Scores were given according to four parameters namely background of smears, staining pattern, cell morphology and nuclear staining. Quality index was calculated from the ratio of score achieved to the possible maximum score.Results:The most common organs involved were ovaries (46 %) followed by liver (11%) and most common lesions were malignant (68 %). The cytological characteristic showed significant difference in all four parameters (P<0.05) when MUFP stain smears were compared with PAP stain smears. There was also statistically significant difference when cumulative score and Quality Index were compared (P<0.001) between the two stains.Conclusion:The US guided Fine needle aspiration (FNA) is simple, safe, rapid and inexpensive technique useful in cytological diagnosis. MUFP stain is fast, reliable and has better diagnostic utility for cytological diagnosis when compared to PAP stain.

Stroke in young among exposed to high altitude: prospective observational study in Eastern India

Background: High altitude deployment for longer duration is a usual event among armed forces personnel. Despite our knowledge and understanding about the risk factors and treatment, stroke still remains the second leading cause of death worldwide. Present study was carried out at a teaching hospital in India, where many soldiers from high altitude area in Eastern India were referred for super speciality care. Our objective was to study the various clinical presentations and risk factors in patients of stroke in age group 15-49 years having longer duration of stay at high altitude.Methods: Patients of stroke between ages 15-49 years, referred to a tertiary care service hospital were treated and evaluated for potential risk factors including prothrombotic factors and analysed using SPSS 15.0.Results: Mean age of patients of cerebral venous thrombosis (CVT), ischemic and hemorrhagic strokes in high altitude area (HAA) was 31.40, 38.68 and age of 38.60 years respectively. Mean Hemoglobin (Hb), homocysteine, serum protein C and S, and antithrombin III levels of HAA ischemic strokes patient was significantly higher than non high altitude area (NHAA) Patients. In case of CVT the difference in mean Serum protein S level of HAA and NHAA patients was significant. There was no statistical difference observed in mean values of serum homocysteine, protein C, protein S and antithrombin III among ischemic stroke and CVT patients in HAA.Conclusions: Prothrombotic state in case of CVT and ischemic strokes is an important risk factor in case for strokes among young individuals in HAA.

Diabetes education and basic insulin related knowledge assessment in nursing staff in a tertiary care hospital in India

Nursing staff plays a major role in the delivery of insulin to hospitalized patients. We aimed at studying the adequacy of desired knowledge related to insulin in nursing staff in a tertiary care government-funded teaching hospital in India. A cross-sectional descriptive design study was conducted to assess the basic insulin-related knowledge in nursing staff by a self-administered questionnaire. A total of 101 nursing staff accepted to participate in the study and returned the completed questionnaire. Forty-one participants were female and 60 were male. Almost 80% of participants denied as trained for diabetes management in hospitalized patients in their nursing curriculum. Eighty-seven participants were comfortable giving insulin. Only two participants could identify basal and bolus insulin as the type of insulin needed to manage hyperglycemia. Twenty-five participants could identify the strengths of insulin vials available in India and only 8 could correctly mention the colour code of the corresponding insulin syringe. Only 15 participants could correctly identify the commonly used routes of inulin administration. Thirty participants could identify all the correct subcutaneous injection sites, however, at least one wrong site was chosen by 78 participants and 8 participants did not answer. A similar deficit in knowledge was seen in hypoglycemia management, glucose monitoring, insulin storage, expiry of inulin and injection techniques. This study shows a significant deficit in basic insulin-related knowledge in nursing staff. There is a need for continuous medical education of nursing staff to stay updated on Diabetes management.

Mesh infection in cases of polypropylene mesh hernioplasty.

Mesh hernioplasty is the most common surgery for hernia repair with Polypropylene mesh as the preferred one. But the use of synthetic prosthesis is associated with the inherited risk of developing a prosthetic infection that may manifest even after a very long time as subtle symptoms in the form of fever, myalgia, erythema of overlying skin and in some cases as chronic discharging sinus. With this in view a systematic prospective observational study has been carried out to estimate the incidence of mesh infections, to identify the type of associated organism and to study the outcome of the cases with hernioplasty using Propylene mesh. Mesh hernioplasty performed in all adult patients using propylene mesh exclusively on 161 males and 20 females were considered in this prospective observational study carried out for 3years (2016-2019) at tertiary care centre and teaching hospital in India. A standard size of the propylene mesh and well laid procedures were used for surgery as well as post operative care, identification and culture of microorganism. The patients were followed up to identify any symptoms of SSI or mesh infection. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, USA) for MS Windows. Out of 181 cases, the mesh contamination was observed in 59 cases while total cases of mesh infection were nine (09), which include 07 males and 02 females. The cases that developed infection were of mostly groin hernias. The cases commonly presenting with erythema, seroma and surgical wound dehiscence with identification of methicillin sensitive Staphylococcus aureus (MSSA) in the few samples of the wound discharge were managed conservatively and none of the cases had to undergo mesh explantation. Of the numerous factors viz. age, sex, associated co-morbidities, educational status, socio-economic status, duration of surgery and expertise of the operating surgeon, the two factors viz. duration of surgery and the mesh contamination were found to be associated with mesh infection in a statistically significant way. The incidence of mesh infection was observed in 4.97% of total 181 cases. To the best of knowledge, this seems to be the first prospective observational carried out in this country. Of the numerous factors studied, the duration of surgery and mesh contamination were the factors found to have statistical significance on the incidence of mesh infection. Although a clear picture to differentiate surgical site infection from acute mesh infection is yet to be obtained, the study provided better understanding of the management as no mesh explantation was required in either of the cases.

Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India

BackgroundFever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever.MethodThis prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100 °F (37.7 °C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled.ResultsA total of 302 children were included in the study, out of which 47% (95% CI 41.4–52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI.ConclusionThe study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

Clinical Spectrum and Outcome of Neurosarcoidosis: A Retrospective Cohort Study from a Teaching Hospital in India.

Context:Neurosarcoidosis (NS) is a chronic disease with a diverse clinical spectrum, therapeutic response, and outcome. There is scarce literature from our country regarding the same.Aims:The aim of this study was to evaluate the clinical spectrum, therapeutic responses, and outcomes of NS in an Indian cohort.Settings and Design:In a cross-sectional study, we included all patients with NS treated at a quaternary care teaching hospital in India from January 2007 to October 2019.Subjects and Methods:Patients older than 18 years of age fulfilling the diagnostic criteria for NS from the Neurosarcoidosis Consortium Consensus Group were included in the study. The therapeutic response and the degree of disability at last follow-up were assessed.Results:We identified 48 patients, among them 3 were categorized as having definite NS, 30 probable NS, and 15 possible NS. Cranial neuropathy was the most common presentation (47.9%), followed by myelopathy (25%). Systemic involvement was identified in 95.83% and mediastinal lymph nodes were the most common site. Clinical improvement was seen in 65.8% and disease stabilized in 28.9%, while 5.26% deteriorated. Fifty percent recovered without any residual disability, while 26.3% had minor and 23.7% had major residual sequelae.Conclusions:NS is a diverse illness, with a heterogeneous spectrum of clinical presentation, treatment response, and outcome. Cranial neuropathy is the most common presenting feature and has a good prognosis while myelopathy has an unfavorable prognosis. Meningeal and brain parenchymal disease is difficult to diagnose accurately unless systemic involvement is present. The diagnosis of NS should be clinically suspected in the appropriate clinical setting, the presence of systemic involvement should be investigated, and histologic confirmation should be attempted.

Impact of planned teaching program on the attitude of nurses with regard to patient rights in two multispecialty teaching hospitals in India.

BACKGROUND:The attitude of nurses with regard to patients' rights bears greater influence on its practice in the health-care settings. As health-care organizations grow toward standardization, positive changes in the attitude of health-care professionals are demanding.OBJECTIVES:The objectives of this study were to assess the attitude of nurses with regard to patient rights in two teaching hospitals, to devise a training program on patient rights for nurses, and to compare the impact of training with regard to patient rights on the attitude of nurses in two teaching hospitals.MATERIALS AND METHODS:This quasi–experimental study with one-group pre- and post-test research design for a sample of 200 nurses was carried out during the year 2017 at two multispecialty hospitals in India. The sample size was selected based on convenience sampling method. For the pretest, attitude was measured on a 5-point Likert scale through a questionnaire containing 27 items. Small-group teaching method was used to train nurses in groups of 8–10. Posttest was done through the same attitude questionnaire 1 week after the training program.RESULTS:In both the hospitals, the nurses had a favorable attitude toward patient rights before the training program; after training, majority of the nurses had the most favorable attitude toward patient rights. A statistically significant difference was observed in the attitude of nurses with regard to patient rights within the hospitals, before and after training nurses on patient rights (P < 0.001).CONCLUSIONS:Health-care organizations require developing planned teaching programs for nursing care professionals in order to influence their knowledge and attitude on patient rights. Their positive attitude toward patient rights leads to improved outcomes and effective nursing care practices.

A Two Years Study to Determine the Etiology and Risk Factor of Discharging Ear Below One Year of Age in a Tertiary Paediatric Health Care Teaching Hospital in India

A Two Years Study to Determine the Etiology and Risk Factor of Discharging Ear Below One Year of Age in a Tertiary Paediatric Health Care Teaching Hospital in India

Epidemiological & clinical characteristics & early outcome of COVID-19 patients in a tertiary care teaching hospital in India: A preliminary analysis.

Background & objectives:In this study we describe the epidemiological data, comorbidities, clinical symptoms, severity of illness and early outcome of patients with coronavirus disease 2019 (COVID-19) from a tertiary care teaching hospital in New Delhi, India.Methods:In this preliminary analysis of a prospective observational study, all adult patients admitted to the screening intensive care unit (ICU) of the institute who fulfilled the WHO case definition of COVID-19 and confirmed to have SARS-CoV-2 infection by reverse transcription-polymerase chain reaction were included. Demographics, clinical data and 24 h outcome were assessed.Results:The preliminary analysis of 235 patients revealed that the mean age was 50.7±15.1 yr and 68.1 per cent were male. Fever (68.1%), cough (59.6%) and shortness of breath (71.9%) were the most common presenting symptoms. Hypertension (28.1%) and diabetes mellitus (23.3%) were the most common associated comorbid illnesses. Patients with mild, moderate, severe and critical illness were 18.3, 32.3, 31.1 and 18.3 per cent, respectively, at the time of ICU admission. The proportions (95% confidence interval) of patients requiring any form of oxygen therapy, oxygen therapy by high-flow nasal cannula and invasive mechanical ventilation were 77, 21.7 and 25.5 per cent, respectively, within 24 h of hospital admission. The 24 h ICU mortality was 8.5 per cent, and non-survivors had higher respiratory rate (P<0.01, n=198) and lower baseline oxyhaemoglobin saturation (P<0.001, n=198) at presentation and higher baseline serum lactate (P<0.01, n=122), total leucocyte count (P<0.001, n=186), absolute neutrophil count (P<0.001, n=132), prothrombin time (P<0.05, n=54) and INR (P<0.05, n=54) compared to survivors.Interpretation & conclusions:Nearly half of the patients presented with severe and critical disease and required high-flow nasal oxygen or invasive mechanical ventilation at admission. Severity of the presenting respiratory illness, haematological parameters and lactate rather than age or presence of comorbidity predicted early death within 24 h.

Antimicrobial-associated adverse drug reaction profiling and assessing the agreement between the WHO-UMC scale and the Naranjo algorithm for causality assessment at a tertiary care teaching hospital in India

Background: Adverse drug reactions (ADRs) are not uncommon due to medications, especially antimicrobials (AMs), given to the patients during their stay in the hospital. Aim and Objective: The present study aims to assess the ADRs related to AMs, causality assessment using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment scale and the Naranjo scale and to evaluate their agreement. Materials and Methods: A prospective, observational study conducted over a period of one year in general medicine and pulmonary medicine wards, including 206 patients. WHO-UMC scale and the Naranjo algorithm were used to assess the causality followed by evaluating the agreement between these two scales. Results: The most common antibiotic accounted for ADRs was Piperacillin+Tazobactam (36.10%). The most common organ system involved was gastrointestinal (83.30%), followed by skin and soft tissue (11.10%) and immunological (5.60%). While 58.30% of the ADRs were latent in onset, 30.60% and 11.10% were sub-acute and acute, respectively. The majority of the ADRs were mild (66.70%), followed by moderate (22.20%) and severe (11.10%) in nature. As per the WHO-UMC scale, 19.4% ADRs were certain, 47.2% were probable, 27.8% were possible, and 5.6% were found to be unlikely. As per Naranjo algorithm, 75% of the ADRs were probable and 25% were of possible. Overall agreement analysis showed “Poor” agreement between the WHO-UMC scale and the Naranjo algorithm (kappa statistics with 95% confidence interval = 0.2195 [0.0065, 0.4325]). Conclusion: Using both the WHO-UMC scale and the Naranjo algorithm is advisable for better evaluation of ADRs related to AMs.

Experience with the management of pediatric laryngopharyngeal reflux in an Indian teaching hospital

Aim: Laryngopharyngeal reflux (LPR) is the retrograde flow of gastric content to the larynx and pharynx where these materials come in contact to the upper aerodigestive tract. This clinical entity is less studied among the pediatric population. The objective of this study is to evaluate the impact of LPR in the pediatric population. Materials and Methods: This retrospective study was done in between December 2016 and January 2019. Clinical data such as associated symptoms, endoscopic findings, laboratory testing, therapeutic interventions, and outcome were analyzed. Endoscopic findings were considered to be consistent with LPR in the pediatric age included: Lingual tonsil hypertrophy, postglottic edema, true vocal fold edema and congested and swollen arytenoids, congested inter-arytenoids area. Results: There were 212 children evaluated for dysphonia. There were 38 girls (52.77) and 34 boys (47.22%), and mean age at presentation was 9.32 years with a male-to-female ratio of 0.89:1. Out of 212 children who underwent endoscopy, 72 had shown LPR disease. Five children (6.94%) showed vocal nodules, 3 (4.16%) showed vocal fold cyst, and 2 (2.77%) children showed subglottic edema along with LPR. All the children were treated with anti-reflux measures. By second follow-up visit on 1 month, 68 children (94.44%) had improved symptomatically. Conclusion: LPR appears to cause laryngeal manifestations more commonly in children. In this study, all the children were presenting dysphonia, intermittent cough, foreign-body sensation in throat, and throat-clearing habit. All of them showing congested arytenoids and inter-arytenoid membrane. Early diagnosis and treatment often result in the improvement of hoarseness of voice and prevent complications. LPR in the pediatric population is almost a new diagnosis.